A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children

Abstract

Distal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and nonoperative methods of treating distal radius fractures in children. MethodsThis is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student's t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher's exact test was used. ResultsSeventy-seven patients were conservatively managed with cast immobilization ("non-operative" group) in comparison to 99 patients who were surgically managed ("operative" group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail. ConclusionThis study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study

“…Continuous data are represented by mean ± standard deviation, binary data are represented by n and percentages are statistically analysed. The comparison of variables between the two groups is tested using one‐way ANOVA, 17 , 18 and a p ‐value <0.05 indicates statistical significance. The significance of ANOVA is used as the p‐value for data that satisfies normal distribution and homogeneity of variance tests.…”

Distal Radius Fractures in Childhood - Our Five-Year Experience

“…In 189 children under 16 years of age with displaced distal radius fractures undergoing conservative treatment, there are statistically significant differences between normal weight and obese patients in terms of the number of the loss of reduction (p=0,002), severity of initial translation (p=0,008) and quality of initial reduction (p=0,01) (Vescio et al, 2022). Among 176 children with fractures of the distal radius treated in the Emergency Department of the Bahrain Defense Force Hospital during a retrospective cohort study from January 1, 2015, to February 1, 2022, 77 patients are conservatively managed with cast immobilization while 99 are surgically managed -56 with percutaneous pinning or 43 flexinail (Aladraj et al, 2022). There are statistically reliable differences in radial inclination between conservative and percutaneous pinning (22,22±2,860 versus 18,76±3,330) (p<0,001) and between percutaneous pinning and flexinail (18,76±3,330 versus 22,37±3,440).…”

Clinical Outcomes of Minimally Invasive Fixation with Pre‐Bent Elastic Stable Intramedullary Nails for the Treatment of Distal Radius Metaphyseal Diaphysis Junction Fractures in Children

“…Each item was assigned a specific score. The scores were categorized into four levels, namely excellent (0-2), good (3)(4)(5)(6)(7)(8), fair (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and poor (≥21).…”

“…The standard treatment for DRMDJ fractures is closed reduction and cast fixation, which is the first‐line treatment option 4 . Nevertheless, surgical intervention is recommended for displaced and unstable fractures or cases with poor alignment after closed reduction 5 . Treatment decisions also depend on fracture characteristics and the preferences of the patient's family.…”